title: Desflurane/fentanyl compared with sevoflurane/fentanyl on awakening and quality of recovery in outpatient surgery using a laryngeal mask airway: a randomized, double-blinded controlled trial.
abstract: OBJECTIVE
  To compare time to awakening and upper airway morbidity between desflurane and sevoflurane using a Laryngeal Mask Airway (LMA) and a balanced anesthetic regimen inclusive of opioids.
  
  
  METHODS
  Randomized, double-blinded, placebo-controlled clinical trial.
  
  
  METHODS
  Ambulatory surgery unit of a university hospital.
  
  
  METHODS
  80 subjects receiving general anesthesia for outpatient gynecological surgery using a LMA.
  
  
  METHODS
  Desflurane/fentanyl or sevoflurane/fentanyl were used for anesthetic maintenance.
  
  
  METHODS
  Patients were randomly assigned to receive desflurane or sevoflurane. The primary outcome was time to awakening as determined by an observer who was blinded to study group allocation. Secondary outcomes included the frequency of sore throat, cough, and pain perioperatively and at 2 and 24 hours postoperatively. Quality of recovery (QoR; via QoR-40 questionnaire) at 24 hours also was determined.
  
  
  RESULTS
  The median (IQR) time to eye opening following desflurane was 6.8 (5.0 - 9.8) minutes versus 11.8 (8.8 - 14.6) minutes following sevoflurane (P < 0.001), or a difference of 5.0 (99% CI 2.3 - 6.8) minutes. The median difference in response to verbal commands was 5.3 (99% CI 2.4 - 7.1) minutes. The frequency of cough, laryngospasm, sore throat, and hoarseness did not differ between groups. Quality of recovery at 24 hours was better in the desflurane group: difference in medians 6 (99% CI 0 - 12; P = 0.003).
  
  
  CONCLUSIONS
  Desflurane retains faster awakening properties than does sevoflurane when used in combination with fentanyl as part of anesthetic maintenance in outpatient surgery with a LMA. The balanced anesthetic maintenance regimen seems to reduce the potential airway reactivity properties of desflurane.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. Electronic address: g-jr@northwestern.edu.
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Fitzgerald
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Shireen
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: R Jay
authors.initials: RJ
authors.lastname: Marcus
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000494:pharmacology; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000494:pharmacology*; D003371:Cough / Q000139:chemically induced; D000077335:Desflurane; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D015907:Hysteroscopy; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D053208:Kaplan-Meier Estimate; D017214:Laryngeal Masks; D008738:Methyl Ethers / Q000009:adverse effects / Q000494:pharmacology*; D008875:Middle Aged; D010612:Pharyngitis / Q000139:chemically induced; D011183:Postoperative Complications / Q000139:chemically induced; D011446:Prospective Studies; D000077149:Sevoflurane
chemical_list: D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D005283:Fentanyl
keywords: Awakening from anesthesia; Desflurane; Recovery from surgery; Sevoflurane